CLINICAL IMAGES PEER REVIEWED | OPEN ACCESS

www.edoriumjournals.com

International Journal of Case Reports and Images (IJCRI)International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.

Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.

IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

Website: www.ijcasereportsandimages.com

Dynamic breast deformity in a male

Martijn van Dorp, Johan Somville

ABSTRACT

Abstract is not required for Clinical Images

(This page in not part of the published article.)

International Journal of Case Reports and Images, Vol. 7 No. 6, June 2016. ISSN – [0976-3198]

Int J Case Rep Images 2016;7(6):416–418. www.ijcasereportsandimages.com

Dorp et al. 416

CASE REPORT OPEN ACCESS

Dynamic breast deformity in a male

Martijn van Dorp, Johan Somville

CASE REPORT

A 60-year-old male presented with a firm swelling of the right breast. Physical examination showed a dynamic breast deformity, also known as an animation deformity, during pectoralis muscle contraction (Figure A and B). Commonly, a dynamic breast deformity is seen following subpectoral breast augmentation. Magnetic resonance imaging scan revealed a well-described capsulated

Martijn van Dorp1, Johan Somville2

Affiliations: 1MD, Plastic Surgery Resident, Department of Plastic Surgery, Antwerp University Hospital, Antwerp, Belgium; 2MD PhD, Professor in Orthopaedic Surgery, Department of Orthopaedic Surgery, Antwerp University Hospital, Antwerp, Belgium.Corresponding Author: Martijn van Dorp, Antwerp, Belgium, 2000; Email: martijnvandorp@icloud.com

Received: 04 November 2015Accepted: 16 March 2016Published: 01 June 2016

mass in the subpectoral plane of 20x20 cm (Figure C). Complete resection of the mass was performed after incisional biopsy (Figure D). Upon histopathological analysis (Figure E), the diagnosis was made of a well-differentiated adipocytic (lipoma-like) liposarcoma. This tumor entity consists of a proliferation of mature adipocytes of variable size together with few lipoblasts and atypical stromal cells (arrows).

CliNiCAl imAgES PEER REviEwEd | OPEN ACCESS

Figure 1: (A, B) Clinical photograph of the dynamic breast deformity, (C) Sagittal T1-weighted magnetic resonance image reveals a well-described capsulated mass in the subpectoral plane, (D) Photograph of the surgical specimen, (E) Histological photomicrograph H&E stain, bar: 50 µm.

DISCUSSION

To date, the available research regarding the dynamic breast deformity is based on subpectoral augmentation mammoplasty or implant-based breast reconstruction and no reports have come out regarding the presence of the dynamic breast deformity due to a neoplasm. Dynamic breast deformity, or animation deformity, is a common term in the field of aesthetic breast surgery and may be a result of subpectoral breast augmentation. When creating a subpectoral pocket plane, during augmentation mammoplasty, the overlying musculature

International Journal of Case Reports and Images, Vol. 7 No. 6, June 2016. ISSN – [0976-3198]

Int J Case Rep Images 2016;7(6):416–418. www.ijcasereportsandimages.com

Dorp et al. 417

retains its contractile ability. As a result the implant will be compressed when the muscle contracts. Typically this movement tends to draw the implant in an upward and outward directions and this directed compression creates a contour deformity in the breast. The deformity can easily be seen when the patient places her hands on the hips and pushes inwards [1].

Especially in the thin patient, the subpectoral plane has the benefit of having enhanced soft-tissue coverage of the prosthetic device. Whereby the potential for visible implant contours is minimalized and the incidence of capsular contraction is reduced. Alternatively, the subglandular plane is provided with the advantage of having more upper pole fullness and no animation deformity [2].

The magnitude of the deformity caused by the animation is highly variable and is usually only minimal to moderate in severity. At times, the degree of distortion of the implant can be dramatic and lead to patient dissatisfaction [3]. In transgender woman, subpectoral implantation carries increased risk of animation deformity due to the masculine pectoralis muscle [4]. Contraction-induced deformities are directly related to muscle strength and inversely related to the amount of breast tissue present [5].

Resolution of the animation deformity in augmentation mammoplasty may be achieved with a pocket change to the subglandular position and suturing the pectoralis major muscle down to the chest wall [1, 6]. Also, a biplane pectoralis muscle splitting technique has been described [7]. Alternatively, selective neurectomy of the medial pectoral nerve or botulinum toxin type A has been proposed to prevent the contraction of the pectoralis and may provide relief of muscular distortion [8].

CONCLUSION

Dynamic breast deformity is a common term in the field of aesthetic breast surgery in woman. However, as described in this extraordinary case, the dynamic breast deformity can be observed due to the presence of a subpectoral liposarcoma in a male patient.

Keywords: Breast deformity, Breast augmentation, Muscle contraction, Swelling

How to cite this article

van Dorp M, Somville J. Dynamic breast deformity in a male. Int J Case Rep Images 2016;(6):416–418.

Article ID: Z01201606CL10100MD

*********

doi:10.5348/ijcri-201607-CL-10100

*********

Author ContributionsMartijn van Dorp – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be publishedJohan Somville – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

GuarantorThe corresponding author is the guarantor of submission.

Conflict of InterestAuthors declare no conflict of interest.

Copyright© 2016 Martijn van Dorp et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.

REFERENCES

1. Hammond DC, Schmitt WP, O’Connor EA. Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 2015 Jun;135(6):1540–4.

2. Spear SL, Schwartz J, Dayan JH, Clemens MW. Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 2009 Jan;33(1):44–8.

3. Pelle-Ceravolo M, Del Vescovo A, Bertozzi E, Molinari P. A technique to decrease breast shape deformity during muscle contraction in submuscular augmentation mammaplasty. Aesthetic Plast Surg 2004 Sep-Oct;28(5):288–94.

4. Kanhai RC, Hage JJ, Asscheman H, Mulder JW. Augmentation mammaplasty in male-to-female transsexuals. Plast Reconstr Surg 1999 Aug;104(2):542–9; discussion 550–1.

5. Strasser EJ. Results of subglandular versus subpectoral augmentation over time: one surgeon’s observations. Aesthet Surg J 2006 Jan-Feb;26(1):45–50.

6. Lesavoy MA, Trussler AP, Dickinson BP. Difficulties with subpectoral augmentation mammaplasty and its correction: the role of subglandular site change in

International Journal of Case Reports and Images, Vol. 7 No. 6, June 2016. ISSN – [0976-3198]

Int J Case Rep Images 2016;7(6):116–418. www.ijcasereportsandimages.com

Dorp et al. 418

revision aesthetic breast surgery. Plast Reconstr Surg 2010 Jan;125(1):363–71.

7. Khan UD. Dynamic breasts: a common complication following partial submuscular augmentation and its correction using the muscle-splitting biplane

Access full text article onother devices

Access PDF of article onother devices

technique. Aesthetic Plast Surg 2009 May;33(3):353–60.

8. Maxwell GP, Tornambe R. Management of mammary subpectoral implant distortion. Clin Plast Surg 1988 Oct;15(4):601–11.

EDORIUM JOURNALS AN INTRODUCTION

Edorium Journals: On Web

About Edorium JournalsEdorium Journals is a publisher of high-quality, open ac-cess, international scholarly journals covering subjects in basic sciences and clinical specialties and subspecialties.

Edorium Journals www.edoriumjournals.com

Edorium Journals et al.

Edorium Journals: An introduction

Edorium Journals Team

But why should you publish with Edorium Journals?In less than 10 words - we give you what no one does.

Vision of being the bestWe have the vision of making our journals the best and the most authoritative journals in their respective special-ties. We are working towards this goal every day of every week of every month of every year.

Exceptional servicesWe care for you, your work and your time. Our efficient, personalized and courteous services are a testimony to this.

Editorial ReviewAll manuscripts submitted to Edorium Journals undergo pre-processing review, first editorial review, peer review, second editorial review and finally third editorial review.

Peer ReviewAll manuscripts submitted to Edorium Journals undergo anonymous, double-blind, external peer review.

Early View versionEarly View version of your manuscript will be published in the journal within 72 hours of final acceptance.

Manuscript statusFrom submission to publication of your article you will get regular updates (minimum six times) about status of your manuscripts directly in your email.

Our Commitment

Favored Author programOne email is all it takes to become our favored author. You will not only get fee waivers but also get information and insights about scholarly publishing.

Institutional Membership programJoin our Institutional Memberships program and help scholars from your institute make their research accessi-ble to all and save thousands of dollars in fees make their research accessible to all.

Our presenceWe have some of the best designed publication formats. Our websites are very user friendly and enable you to do your work very easily with no hassle.

Something more...We request you to have a look at our website to know more about us and our services.

We welcome you to interact with us, share with us, join us and of course publish with us.

Browse Journals

CONNECT WITH US

Invitation for article submissionWe sincerely invite you to submit your valuable research for publication to Edorium Journals.

Six weeksYou will get first decision on your manuscript within six weeks (42 days) of submission. If we fail to honor this by even one day, we will publish your manuscript free of charge.*

Four weeksAfter we receive page proofs, your manuscript will be published in the journal within four weeks (31 days). If we fail to honor this by even one day, we will pub-lish your manuscript free of charge and refund you the full article publication charges you paid for your manuscript.*

This page is not a part of the published article. This page is an introduction to Edorium Journals and the publication services.

* Terms and condition apply. Please see Edorium Journals website for more information.